26HS0006_-_CUF_Form.pdf
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- Solicitation number
- 0000037729
- Issued by
- Fresno County, Kings County, Madera County, Merced County, Monterey County, San Benito County, Santa Clara County, Santa Cruz County, Fresno City, Kingsburg City, Monterey Park City, Madera City, Madera Acres CDP, Madera Ranchos CDP, Corte Madera Town, Merced City, University of California-Merced CDP, Monterey City, Kings Beach CDP, Santa Clara City, Santa Cruz City, Monterey Park Tract CDP, California
About this file
This is a Commercially Useful Function (CUF) Certification Form from the State of California Department of Veterans Affairs for Solicitation Number 26HS0006, which pertains to fire protection system services (sprinklers and hydrants) required by the Veterans Services California Correctional Continuum Village (CCCVC). The solicitation is exclusively for California-certified Disabled Veteran Business Enterprise (DVBE) firms. Certified Small Business (SB), Micro Business (MB), and DVBE prime contractors, subcontractors, or suppliers must complete this form if they will perform any element of the work. The form requires respondents to address five key questions regarding their role in the contract execution, including whether the business will be responsible for a distinct element of work, will actually perform or manage the work, will perform services normal to their business operations, will subcontract work beyond normal industry practices, and will serve merely as a pass-through entity for funding purposes. Specifications for the required services are detailed in the Scope of Work found in Exhibits A-D documents, with all questions to be submitted via email according to the solicitation timeline.
Completion of this form is mandatory for all certified DVBE, SB, and MB entities bidding on this contract. Responses of "No" to questions 1-3 or "Yes" to question 4 may result in the quote being deemed non-responsive and disqualified. Respondents must provide a written statement detailing the role, services, and goods their company will provide to meet commercially useful function requirements as defined under Government Code Section 14837(d)(4) and Military and Veterans Code Section 999(b)(5)(B). The authorized representative signing the form must be the certified business owner or authorized corporate representative and certifies under penalty of perjury that all information is truthful and accurate. The State may require additional clarifying information prior to contract award at its discretion.
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State of California Department of Veterans Affairs
COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM
CV 012 (REV. 08/2023) Page 1 of 2
Solicitation Number:
Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.
1. CONTRACTOR NAME (Completing Form) "DOING BUSINESS AS" (DBA) NAME: OSDS REF # (Currently certified firms only): Expiration Date:
2. COMMERCIALLY USEFUL FUNCTIONS (CUF)
All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).
Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:
Mark all that apply: DVBE Small Business Micro Business
1 If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work? Yes No
2 If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved? Yes No
3 If awarded a contract, will you perform work that is normal for your business, service and functions? Yes No
4 If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices? Yes No
5 If awarded a contract, will your business role be limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation? Yes No
A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.
3. WRITTEN STATEMENT
Provide a written statement below detailing the role, services and goods your company will provide to meet the commercially useful function requirement. At the State's option prior to award, you may be required to submit additional clarifying information
State of California Department of Veterans Affairs
CV 012 (REV. 08/2023) Page 2 of 2
AUTHORIZING SIGNATURE (REQUIRED)
The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.
AUTHORIZED REPRESENTATIVE SIGNATURE: TITLE:
PRINTED NAME: DATE:
State of California Department of Veterans Affairs
CV 012 (REV. 08/2023) Page 1 of 2 Every certified SB, MB & DVBE must complete this form if they will perform an element of the work.
1. CONTRACTOR NAME (Completing Form)
2. COMMERCIALLY USEFUL FUNCTIONS (CUF)
All certified Small Business, Micro Business, and/or DVBE prime contractors, subcontractors or suppliers must meet the commercially useful function requirements under Government Code, Section 14837 (d)(4) (for SB) and Military and Veterans Code, Section 999(b)(5)(B) (for DVBE).
Please answer the following questions, as they apply to your company for the goods and services being acquired in this solicitation:
Mark all that apply:
If awarded a contract, will your business be responsible for the execution of a distinct element of the resulting work?
If awarded a contract, will your business carry out the obligation of the contract by actually performing, managing, or supervising the work involved?
If awarded a contract, will you perform work that is normal for your business, service and functions?
If awarded a contract, will your business subcontract a portion of the work greater than would be expected by normal industry practices?
If awarded a contract, will your business role be limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SB and/or DVBE participation?
A response of "No" in questions 1-3 or a response of "Yes" in question 4 may result in your quote being deemed non-responsive and disqualified.
3. WRITTEN STATEMENT
State of California Department of Veterans Affairs
COMMERCIALLY USEFUL FUNCTION (CUF) CERTIFICATION FORM
CV 012 (REV. 08/2023) Page 2 of 2
AUTHORIZING SIGNATURE (REQUIRED)
The signatory of this document must be the certified business owner (or authorized representative in the case of a corporation) and as such, hereby certifies under penalty of perjury under the laws of the State of California that all information provided herein is truthful and accurate.
9.0.0.2.20101008.1.734229
| SolicitationNumber: 26HS0006 |
| DoingBusinessAs: |
| OSDSRefNumber: |
| ExpirationDate: |
| : |
| Yes: |
| No: |
| ProvideAWrittenStatement: |
| AuthorizedRepresentative: |
| Title: |
| PrintedName: |
| Date: |
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